registration form for commercial employers, pacific maritime, and

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registration form for commercial employers, pacific maritime, and
This form will be the basic record of YOUR
ACCOUNT. DO NOT FILE THIS FORM UNTIL
YOU HAVE PAID WAGES THAT EXCEED
$100.00. Please read the INSTRUCTIONS on the
back before completing this form. PLEASE PRINT
OR TYPE.. Return this form to:
EMPLOYMENT DEVELOPMENT DEPARTMENT
ACCOUNT SERVICES GROUP MIC 28
PO BOX 826880
SACRAMENTO CA 94280-0001
(916) 654-7041
FAX (916) 654-9211
www.edd.ca.gov
REGISTRATION FORM FOR COMMERCIAL EMPLOYERS, PACIFIC MARITIME, AND FISHING BOATS
ACCOUNT NUMBER
QUARTER
ON-LINE PROCESS DATE
TAS CODE
DEPT.
USE
Industry specific registration forms are required relative to each type of employer. Please use the appropriate form to register.
Commercial/Pacific Maritime/Fishing Boat
DE 1
Household Workers
DE 1HW
Agricultural
DE 1AG
Non-profit
DE 1NP
Government/Public Schools/Indian Tribes
DE 1GS
Personal Income Tax Only
DE 1P
A.
THIS IS A:
New business
Hired employees
Change in form - (Individual to corporation; partnership to corporation; merger; corporation to LLC, etc.)
Change of partner(s)
Purchased on-going business
All
Part
Other
IF THE BUSINESS WAS PURCHASED, PROVIDE THE FOLLOWING INFORMATION:
Previous Owner
B.
C.
Business Name
HAVE YOU EVER REGISTERED A
BUSINESS WITH THE DEPARTMENT?
No
Yes
Purchase Price
Date of Transfer
IF YES, ENTER THE FOLLOWING:
ACCT NUMBER
BUSINESS NAME
INDICATE FIRST QUARTER AND YEAR IN WHICH WAGES EXCEED $100.
EDD Account Number
ADDRESS
Jan.-Mar. 20
Apr.-June 20
July-Sept. 20
OWNERSHIP BEGAN OPERATING
D.
BUSINESS NAME (DBA)
E.
INDIVIDUAL OWNER
F.
CORPORATION/LLC/LLP/LP NAME
G.
List all partners*, corporate officers, or
LLC/LLP members/managers/officers
MONTH:
DAY:
Oct.-Dec. 20
FEDERAL I.D. NUMBER
YEAR:
SOCIAL SECURITY NUMBER
DRIVER’S LICENSE #
SECRETARY OF STATE CORP/LLC/LLP/LP I.D. NO.
TITLE
SOCIAL SECURITY NUMBER
(partner, officer title, LLC/LLP
member/manager)
DRIVER’S LICENSE #
*If entity is a Limited Partnership, indicate General Partner with an (*). List additional partners, LLC/LLP members/officers/managers on a separate sheet.
H.
MAILING ADDRESS
CITY
STATE
ZIP CODE
PHONE NUMBER
(
)
I.
BUSINESS ADDRESS (if different from mailing address)
CITY
STATE
ZIP CODE
PHONE NUMBER
(
)
J.
ORGANIZATION TYPE
(IN) INDIVIDUAL OWNER
(HW) HUS/WIFE CO-OWNERSHIP
(GP) GENERAL PARTNERSHIP
(CP) CORPORATION
(AS) ASSOCIATION
(LC) LIMITED LIABILITY CO.
(PL) LIMITED LIABILITY
PARTNERSHIP
(LQ) LIQUIDATION
(LP) LIMITED PARTNERSHIP
(TR) TRUSTEESHIP
(EA) ESTATE ADMINISTRATION
(JV) JOINT VENTURE
(RC) RECEIVERSHIP
(BK) BANKRUPTCY
(OT) OTHER (Specify)
K.
EMPLOYER TYPE
L.
INDUSTRY ACTIVITY: Identify the industry and specific product or service that represents the greatest portion of your sales receipts or revenue. Check one:
SERVICES
(01) COMMERCIAL
RETAIL
(22) PACIFIC MARITIME
WHOLESALE
(25) FISHING BOAT
MANUFACTURING
OTHER
Describe specific product and/or service in detail.
Number of CA Employees
Are there multiple locations for this business?
No
M.
CONTACT PERSON FOR BUSINESS
N.
DECLARATION
These statements are hereby declared to be correct to the best knowledge and belief of the undersigned.
Signature
TITLE/COMPANY NAME
Yes
ADDRESS
Title
PHONE
(
)
Date
(Owner, Partner, Officer, Member, Manager, etc.)
O. PAYROLL TAX EDUCATION: Attend a payroll tax seminar that will help you understand how, what, and when to report state payroll taxes.
Visit our Web site at www.edd.ca.gov/taxsem or call us at (888) 745-3886 for more information.
DE 1 Rev. 71 (4-03) (INTERNET)
Page 1 of 2
CU
INSTRUCTIONS FOR REGISTRATION FORM FOR COMMERCIAL/PACIFIC MARITIME/FISHING BOAT EMPLOYERS
An employer is required by law to file a registration form with the Employment Development Department (EDD) within fifteen (15) calendar
days after paying over $100 in wages for employment in a calendar quarter, or whenever a change in ownership occurs. Please complete all
items on the front of this DE 1 and do one of the following:
• Mail your completed registration form to EDD, Account Services Group MIC 28, PO Box 826880, Sacramento, CA 94280-0001 or
• Fax your completed registration form to EDD at (916) 654-9211 or
• Call for telephone registration at (916) 654-8706
There are industry specific registration forms related to each type of employer. Please use the appropriate form to register. A complete list
of registration forms is located on the front of this form.
NEED MORE HELP OR INFORMATION?
• Call Account Services Group (ASG) in Sacramento at (916) 654-7041 with questions regarding this form or the registration and account
number assignment process.
• Contact the nearest Taxpayer Education and Assistance (TEA) office listed in your local telephone directory under State Government,
EDD or call a TEA Customer Service Representative at 1-888-745-3886 with questions about whether your business entity is subject to
reporting and paying state payroll taxes. For TTY (nonverbal) access, call 1-800-547-9565.
• Access the EDD Web site at www.edd.ca.gov
A. STATUS OF BUSINESS - Check the box that best describes why you are completing this form. If the business was purchased, provide
previous owner and business name, purchase price, date ownership was transferred to this ownership and EDD account number.
B. PRIOR REGISTRATION - If any part of the ownership shown in items E, F, or G are operating or have ever operated at another
location, check "Yes" and provide account number, business name, and address.
C. WAGES - Check the box for the quarter in which you first paid over $100 in wages.
D. BUSINESS NAME - Enter the name by which your business is known to the public. Enter "None" if no business name is used. Enter the
date the new ownership began operating. Enter Federal Employer Identification Number. If not assigned, enter "Applied For".
E. INDIVIDUAL OWNER - Enter the full given name, middle initial, surname, title, social security number, and driver’s license number.
F. CORPORATION/LLC/LLP/LP NAME - Enter Corporation/LLC/LLP/LP name exactly as spelled and registered with the Secretary of
State. Include the California Corporate/LLC/LLP/LP identification number.
G. LIST ALL PARTNERS, CORPORATE OFFICERS, OR LLC/LLP MEMBERS/MANAGERS/OFFICERS - Enter the name, title, social
security number and driver’s license of each individual.
H. MAILING ADDRESS - Enter the mailing address where EDD correspondence and forms should be sent. Provide daytime business
phone number.
I.
BUSINESS ADDRESS - Enter the California address and telephone number where the business is physically conducted. If there is
more than one California location, list the business addresses on a separate sheet and attach to this form.
J. ORGANIZATION TYPE - Check the box that best describes the legal form of the ownership shown in items E, F, or G.
K. EMPLOYER TYPE - Check the box that best describes your employer type.
L. INDUSTRY ACTIVITY - Check the box that best describes the industry activity of your business. Describe the particular product or
service in detail. This information is used to assign an Industrial Classification Code to your business. If you would like more information
on industry coding or the North American Industry Classification System (NAICS), you can visit the Web site:
www.census.gov/epcd/www/naics.html
Enter the number of California employees. Check "Yes" if there are multiple locations under this EDD Account Number.
M. CONTACT PERSON FOR BUSINESS - Enter the name, title/company address, and phone number of the person authorized by the
ownership shown in items E, F, or G to provide EDD staff information needed to maintain the accuracy of your employer account.
N. DECLARATION - This declaration should be signed by one of the names shown in item(s) E or G.
O. PAYROLL TAX EDUCATION - EDD provides educational opportunities for taxpayers to learn how to report employees’ wages and pay
taxes, pointing out the pitfalls that create errors and unnecessary billings. Help is only a telephone call or Web site away.
We will notify you of your EDD Account Number by mail. To help you understand your tax withholding and filing responsibilities, you will
be sent a California Employer’s Guide, DE 44. Please keep your account status current by notifying ASG of all future changes to the
original registration information.
DE 1 Rev. 71 (4-03) (INTERNET)
Page 2 of 2

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